Pharmerica Long-Term Care, LLC

The only time you'll see PharMerica's products is when a nurse hands you a pill in a paper cup. As the country's second-largest institutional pharmacy operator (behind Omnicare), the company provides purchasing, packaging, and dispensing of drugs to hospitals, nursing homes, assisted living facilities, and other long term care settings with more than 330,000 beds. PharMerica operates about 120 institutional pharmacies, including 14 focused on infusion therapies and five for oncology medications, from which it packages and delivers medications in unit doses (rather than in bulk) to its customers in 45 states. It also provides consulting and monitoring services of drug usage to help care facilities comply with government regulations.

Operations

PharMerica's institutional pharmacy segment accounts for a majority of sales. Other revenue comes from the hospital pharmacy management division, which provides onsite management of pharmacies at more than 80 US hospitals in about 20 states, and its infusion business, which operates more than a dozen infusion pharmacies that ship products to homebound patients. Pharmacy management services include patient safety and regulatory compliance, work force optimization, and drug utilization management.

PharMerica offers a number of services through online portals including help with medication management (ordering, refills, discontinues, returns), regulatory updates, formulary guides, billing, reporting, and management and utilization reports. It also offers patient medical record management services.

Geographic Reach

PharMerica operates facilities in more than 40 states and serves customers in 45 states. Its largest operating markets include Texas, California, Florida, Pennsylvania, Tennessee, and Hawaii.

Sales and Marketing

PharMerica receives nearly half of its annual pharmacy services revenue from commercial Medicare Part D Plans. The government reimbursement programs Medicare and Medicaid combined account for about 10%. Other payers include institutional health care providers (30%), commercial insurance companies, private payers, and contracted providers. PharMerica keeps a close eye on changes to federal health care laws and insurance reimbursement policies which have the potential to affect its bottom line.

The company's products and services are promoted through a national direct sales force. Revenues generated from facilities of its largest client, Kindred Healthcare, account for about 9% of sales in 2013 but that contract was not renewed after it expired at the end of the year.

Financial Performance

After a 12% dip in 2012, revenue dropped another 4% in 2013 to $1.9 billion in 2012 due to lower contracted customer accounts in the institutional pharmacy segment. Other factors impacting sales included generic drug conversions.

PharMerica has seen two years of declining net income after increases in the years prior. In 2013 net income dropped 17% as costs for litigation, settlement, selling, and general expenses climbed, partial due to the Amerita acquisition. As the company used less cash for inventory and accounts payable, cash flow improved by $70 million, from $86 million in 2012.

Strategy

By consolidating in what has historically been a highly fragmented market, PharMerica has secured its position as one of the largest institutional pharmacy providers in the country. It has grown geographically by acquiring smaller, regional competitors that operate in markets the company wishes to enter. It also targets new sales and retention of existing clients. To that end, the company is looking to broaden its product and service offerings into new areas. PharMerica continues to expand its digital offerings to keep up with growing demand from customers for such services.

Over the past few years the company has been beefing up the amount of generic drugs it dispenses as a way to reduce costs and capture more customers. More than 80% of the prescription drugs PharMerica dispensed in 2013 were generic (compared to roughly 70% in 2008). This number is likely to increase as more pharmaceutical companies lose exclusivity patents and additional generics are introduced to the market. However, selling generics is a double-edged sword since a shift from brand-to-generic decreases PharMerica's revenue, but at the same time improves gross margins.

During 2012 it added an institutional pharmacy in Clovis, New Mexico. In addition, in 2012 the company expanded its operations into a new business area through the $85 million acquisition of Amerita, a provider of specialty home infusion services in Colorado, Tennessee, Texas, Oklahoma, and Utah. The deal added a dozen infusion pharmacies to PharMerica's operations.